Abstract
We developed a hinged external fixator for the treatment of dislocated intra-articular
calcaneus fractures with severe soft tissue damage. The external fixation was performed
with a known external fixator system. The screw insertion points were biomechanically
tested by defining a virtual rotation axis through the center of the talus to allow
early active motion in the ankle joint. Long-term follow-up was performed after an
average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle
Society (AOFAS) score. Radiographs were reviewed according to Sanders classification.
Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or
compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the
final method of treatment (group I). A change to open reduction with internal fixation
was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group
II). There were no late amputations, osteomyelitis, or malunions. According to Sanders
classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures.
Pin loosening or pin infection was seen in 4 cases, but there was no redislocation.
The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%,
and any shortening or deviation of the axis was corrected in 82% of the cases. The
AOFAS score for the group averaged 66.5. According to Sanders classification, group
II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in
88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation
of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences
in patient outcome scores between open reduction with internal fixation and hinged
fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture
types without soft tissue limitation. The hinged fixator allows early movement in
the ankle joint, the risk of infection is minimized, and secondary plate fixation
remains possible.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Compartment syndrome of the foot after intraarticular calcaneal fracture.Clin Orthop Relat Res. 1991; 269: 241-248
- Calcaneus fractures: facts, controversies and recent developments.Injury. 2004; 35: 443-461
- Compartment syndrome of the foot.Clin Anat. 2001; 14: 184-189
- Displaced intraarticular calcaneal fractures: long-term outcome in women.Foot Ankle Int. 2004; 25: 853-856
- Functional evaluation of intraarticular severely comminuted fractures of the calcaneus with gait analysis.J Foot Ankle Surg. 2004; 43: 374-379
- Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial.J Bone Joint Surg Am 84-A. 2002; : 1733-1744
- Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2-8 year follow-up.Foot Ankle Int. 2004; 25: 657-665
- Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study.Bone Joint Surg Br. 1993; 75: 932-937
- Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management.J Orthop Trauma. 2003; 17: 241-249
- Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion.J Orthop Trauma. 2003; 17: 106-112
- Subtalar arthrodesis for complications of intra-articular calcaneal fractures.Foot Ankle Int. 2000; 21: 392-399
- An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures.Bone Joint Surg Am. 2005; 87: 2741-2749
- Open calcaneal fractures: assessment and management.Foot Ankle Clin. 2005; 10 (491–502, vi, 2005)
- Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures.J Orthop Trauma. 1999; 13: 369-372
- Open fractures of the calcaneus: soft-tissue injury determines outcome.J Bone Joint Surg Am 85-A. 2003; : 2276-2282
- Open calcaneal fractures: results of operative treatment.J Orthop Trauma. 2004; 18: 7-11
- Wound healing complications in closed and open calcaneal fractures.J Orthop Trauma. 2004; 18: 1-6
- Open fractures of the calcaneus: a review of treatment and outcome.J Orthop Trauma. 2004; 18: 202-206
- A staged protocol for soft tissue management in the treatment of complex pilon fractures.J Orthop Trauma. 2004; 18: S32-S38
- Management of calcaneal fracture using the Ilizarov technique.Clin Orthop Relat Res. 2005; 439: 215-220
- Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing.J Foot Ankle Surg. 2004; 43: 43-50
- Injuries of the hindfoot.Clin Orthop Relat Res. 1977; 122: 28-36
- Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases.Clin Orthop Relat Res. 1993; 290: 76-86
- Zwipp H. Chirurgie des Fußes. Wien, New York, Springer1994: 100-129
- [Treatment of calcaneus and mid-foot fractures using closed reposition and fixation with the Ilisarov fixator].Unfallchirurg. 1992; 95: 541-546
- Calcaneal fractures: indirect reduction and external fixation.Foot Ankle Int. 2006; 27: 494-499
- A new perspective on management of open calcaneus fractures.Int Orthop. 2008; 32: 785-790
- [Value of functional treatment of severe calcaneus fractures].Zentralbl Chir. 1990; 115: 619-624
- Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial.Foot Ankle Int. 1996; 17: 2-9
- [Calcaneus fractures. Open reduction and internal fixation].Zentralbl Chir. 2003; 128: 517-528
- Displaced intra-articular calcaneal fractures.J Orthop Trauma. 2005; 19: 360-364
- Surgical treatment of the intra-articular calcaneus fracture.Orthop Clin North Am. 1994; 25: 665-675
- Operatively treated calcaneus fractures: to mobilize or not to mobilize.Univ Penn Orthop J. 2001; 14: 71-73
- [Treatment of intra-articular calcaneus fractures with a para-articular external fixator].Unfallchirurg. 2000; 103: 1065-1072
- A biomechanical evaluation to optimize the configuration of a hinged external fixator for the primary treatment of displaced intra-articular calcaneus fractures with soft tissue damage.J Foot Ankle Surg. 2008; 47: 26-33
- Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification.Clin Orthop Relat Res. 1993; 290: 87-95
- Two-stage operative treatment of comminuted os calcis fractures.Primary indirect reduction with medial external fixation and delayed lateral plate fixation.Clin Orthop Relat Res. 1993; 290: 132-141
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.J Bone Joint Surg Am. 1976; 58: 453-458
- [A new classification of soft-tissue damage in open and closed fractures (author's transl)].Unfallheilkunde. 1982; 85: 111-115
- Dynamic and functional gait analysis of severely displaced intra-articular calcaneus fractures treated with a hinged external fixator or internal stabilization.J Foot Ankle Surg. 2008; 47: 19-25
- Fractures of the os calcis: improved results with internal fixation.Injury. 1993; 24: 263-265
- Complications of intraarticular calcaneal fractures.Clin Orthop Relat Res. 2001; 391: 7-16
- Follow-up evaluation of open intra-articular fractures of the calcaneus.Arch Orthop Trauma Surg. 1998; 117: 442-447
- Reconstruction of soft tissue after complicated calcaneal fractures.Scand J Plast Reconstr Surg Hand Surg. 2004; 38: 284-287
- Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb.Injury. 2007; 38: 824-831
- Soft tissue complications following calcaneal fractures.Foot Ankle Clin. 2007; 12: 107-123
- Open calcaneal fractures: results of operative treatment.J Orthop Trauma. 2004; 18: 7-11
- Open hindfoot injuries.J Am Acad Orthop Surg. 2007; 15: 367-376
- Open fractures of the calcaneus: soft-tissue injury determines outcome.J Bone Joint Surg Am 86-A:2568. 2004;
- Treatment of open intra-articular calcaneal fractures: evaluation of a treatment protocol based on wound location and size.Foot Ankle Int. 2006; 27: 317-323
- Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2-8 year follow-up.Foot Ankle Int. 2004; 25: 657-665
- [Difficulties in evaluating follow-up outcome in calcaneus fracture managed with plate osteosynthesis. Is there a reliable score?].Unfallchirurg. 2000; 103: 295-300
- A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system?.Foot Ankle Int. 2004; 25: 521-525
- [Our experiences with change of osteosynthesis from external fixator to internal fixation in fractures of the lower limb].Zentralbl Chir. 2003; 128: 674-679
- Bohler's angle: correlation with outcome in displaced intra-articular calcaneal fractures.J Orthop Trauma. 1999; 13: 554-558
- Results of an Internet survey determining the most frequently used ankle scores by AOFAS members.Foot Ankle Int. 2005; 26: 479-482
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
- [Open reduction and internal fixation by primary subtalar arthrodesis for intraarticular calcaneal fractures].Oper Orthop Traumatol. 2007; 19: 155-169
- Long-term results of arthrodesis for osteoarthritis of the ankle.Clin Orthop Relat Res. 1999; 361: 178-185
- [Subtalar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases].Rev Chir Orthop Reparatrice Appar Mot. 1994; 80: 728-733
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
